In 1887 Nellie Bly pretended to be insane to be committed to a mental asylum. She was described as insane and a hopeless case. She then published ten days in a mad house which lead to psychiatric standards being improved in New York.

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Laing Aims and Context Rosenhan

Laing suggested it would be best to treat patients such as schizophrenics in the community. Said 'labels' were a way of excluding people from society. Anti-psychiatry movement gave lectures which rosenhan sat in on and inspired him.

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What did Laing Believe?

Diagnosis of mental illness was 'useless at best and downright harmful and missleading at its worst'

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Goffman Aims and Context for Rosenhan

Worked in a mental asylum as member of staff. Found that patients were viewed as a reflection of their label. The patients then went through 'mortification' as they were depersonalised and stripped of all identities.

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Pygmalion Aims and context for Rosenhan

Highlights ideas of self fulfilling prophecy. Teachers were told they had a 'special' group of students with unusual potential, despite them having a range of IQ's. The teachers expectations then became self fulfilling prophecies.

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What did pygmalion study find?

Even the weaker students in the goup experienced showed greater increase in iQ over 8 months than the control group.

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Rosenhan's aim 1?

To find out if psychiatrics could tell the difference between genuinely ill and those who are not, or between the 'normal' and the 'abnormal'.

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Rosehan's aim 2?

To investigate whether the diagnosis of mental illness is based on a patients behaviour or on the environment th epatient is in (labelling) and extent to which this leads to self fulfilling prophecy.

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What was rosenhan's research method?

Participant observation in a natural environment which had a degree of control.

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Rosenhan's sample?

Staff (doctors and nurses) of 12 varied hospitals.

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How many pseudo patients in study 1?

8 (3 females, 5 males including rosenhan himself)

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What did the pseudo patients do?

Tried to get admitted to 12 hospitals in the US saying they were hearing voices (of same sex as them) saying 'empty' 'hollow' 'thud'.

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What did the pseudo patients say whilst there?

Told the truth about themselves (life, history etc) except from their names and for the voices.

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What did patients do when they were admitted?

Behaved normally.

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What was pseudo patients daily routine?

Talking to other patients and making notes - first in secret but then openly because the staff did not care.

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What were the pseudo patients told?

They had to get out by their own devices. No one was going to help them or go to get them.

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What did pseudo's ask staff?

Questions, such as 'pardon me, when am i likely to be discharged?'.

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What did study 2 involve?

Telling another hospital that one pseudo would be coming to them within the next 3 months.

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What scale was involved in study 2?

Hospital rating from 1-10 how confident they felt about the patient being genuine over the next 3 months.

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How many admitted in study 2?

193 aadmitted patients being judged by hospital.

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How did rosenhan address ethical issues?

Keeping identity of hospitals and staff confidential.

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What were pseudo's admitted diagnosed with?

7 of 8 Schizophrenia, 1 with bipolar. - not one of the 8 was detected as fake by the staff.

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What were p's discharged with?

Schizophrenia in remission

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Days p's were kept in?

7 to 52 days, a mean on 19 days.

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How long per day with psychiatrist?

6.8 minutes.

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Rumbled?

Real patients often rumbled the p's by saying things like 'you're not crazy' and 'you're a journalist'.

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Tablets?

Each pseudo patient was given a total of 2,100 tablets, only 2 were swallowed.

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How was normal behaviour viewed?

In the light of the 'insane place', e.g. 'the patient engaged in writing behaviour'.

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Cage?

Staff spent an average of 11% of their shift outside their glass office ('cage'). Came out just 10-11 times per shift

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When can i go home?

When ops asked when they could go home they were largely ignored and little eye contact was made. 88% nurses looked away.

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Uniform?

Rosenhan found a nurse unbuttoned her uniform to adjust her underwear in front of a male ward - not because she was being seductive, but because she thought they were invisible.

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Found in study 2?

41/193 patients were thought to be pseudo's by at least one staff member when in fact Rosenhan sent none.

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Conclusion 1?

Psychiatrists cannot reliably tell who is sane and who is insane.

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Conclusion 2?

When people are in a psychiatric hospital their behaviour is assumed to reflect their insanity.

A diagnosis of schizophrenia becomes a self fulfilling prophecy and patient behaves accordingly.

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Conclusion 5?

Maybe pseudo's were labelled insane because they are biased towards type 2 errors.

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Conclusion 6?

'The mentally ill are society's lepers.'

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Reliability

Strong as variables were kept consistent (same words etc). Also one patient was excluded as he did not follow guidelines so the consistency/reliability was not threatened.

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Internal Validity

Problematic - As 8 pseudo's were not insane, their observations and experiences did not paint a true picture of the insane, e.g. they knew they would be released soon, unlike real patients.

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Sampling

Strong - staff were from a variety of hospitals across america, so generalisations could be made. However all 12 hospitals were in america so it could be culturally bias in favour of western methods.

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Data

Strong - had quant data so gave objective measure of experiences in hospital and enables comparisons e.g. each pp discharged after a mean of 19 days. However qual data was stronger as it provided detailed view of experiences, e.g. being ignored.

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Ethics?

Problematic - doctors and nurses in all 12 hospitals were deceived and believed 8 pseudo's were real. Also in study 2, patients could have been mistreated if they were thought to be fake, so weren't protected. However good as names were confidential.

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Alternative Evidence people for Rosenhan?

Goffman, Pygmalion, Slater.

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Alternative Evidence 1?

Goffman supports as he found that once labelled, behaviour is viewed as reflection of illness. Supports as shows both studies found damaging consequences of self fulfilling prophecies. R is stronger as he was a patient not staff so was more valid.

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Alternative Evidence 2?

Supported by Pygmalion as he also found that ops behaviour was shaped by self-fulfilling prophecies. However Pyg higher on validity as it was a double blind whereas R was a single blind?

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Alternative Evidence 3?

Slater challenges as she repeated rosenhan's experiment by herself and was treated well and not diagnosed. Rejects as Rosenhan's voices lead to immediate diagnosis. Howver R was stronger as there was larger sample, whereas Slater could have bias.

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Front

Laing Aims and Context Rosenhan

Back

Laing suggested it would be best to treat patients such as schizophrenics in the community. Said 'labels' were a way of excluding people from society. Anti-psychiatry movement gave lectures which rosenhan sat in on and inspired him.